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Adolescents: 12-21

A Letter to Parents...

As your child approaches the teen years, especially if it’s your first-born, you find yourself paying attention to the tattoos, body piercing, and clothes of the teenagers you see on the street or in the mall. The realization that your child will soon be “one of them” makes the future seem a little scary.

To bolster your confidence for the days ahead, you focus on the strength of your family ties. You wonder if your family will be protected from the problems others have had with their teens by all the hours you invested in providing transportation, helping with homework, attending recitals, cheering at ball games, the fun of family vacations and holiday celebrations. You find yourself thinking back to the “terrible twos” and wondering if the teen years are just a replay. If the toddler years were easy, you hope you’ll be lucky with adolescence, too. Although you know it’s just a fairy tale, you find yourself wishing for the magic spell in Sleeping Beauty so that your child can sleep peacefully through the teen years and wake up an adult.

You have expectations for what’s about to happen to you, your child, and your family – as does your child. Your expectations are based on your observations of other families, your understanding of this developmental stage, and your own experience as a teenager. There will be times you will be tempted to share your “I had it much worse than you” and “I know exactly what you’re going through” stories with your teen. Proceed with caution. Your stories are your stories. To your teenager, your experiences don’t seem relevant and, even worse, they imply that you don’t give your teen credit for being a unique individual with his or her problems or concerns.

The information on the next few pages has been collected to help you during the years of parenting your teenager. There are also helpful resources at the end of this section. Before moving ahead, however, we suggest you revisit the past. Even though it’s unlikely to help your child relate better to you, it may help you relate better to your child. Recalling the intense emotions and pressures you had as a teenager might make it easier to live with, love, support, and champion your child through this dramatic and wonderful passage to adulthood.

Have a safe journey.

Top 10 Facts You Should Know about Adolescence

Adolescence is the developmental stage between childhood and adulthood. It is more than physical growth and sexual maturation (puberty or biological development). Adolescence includes dramatic and important changes in thought processes of the brain (intellectual or cognitive development) and changes in the way the teen thinks of himself/herself and relates to others (psychosocial or social/emotional development).

The age that puberty begins and ends – and how fast the process goes – can be very different for different individuals and still be normal. Puberty in one girl can start as early as age 8 and proceed to menstrual periods by the time she is 10; while another girl starts breast development at age 11 and does not start menstruating until she is 14.

It is normal for development to proceed steadily for a while and then stop for a few months. This can be especially troubling when a short male grows quickly for a few months and then stops just when his hopes are up.

The three areas of development (physical/sexual, intellectual, and social/emotional) do not necessarily progress at the same rate. This can be troubling for a girl whose sexual development occurs early, making her appear “grown up,” but her social/emotional development is still that of a child; or for a teenage boy who has his growth spurt early, making everyone expect him to act his “height age” – not his chronological age.

There are three stages of adolescence. Early adolescence – the middle-school years: 11, 12, 13, 14. Middle adolescence – the high-school years: 15, 16, 17. Late adolescence – the age of maturity: 18, 19, 20, 21. Each stage is associated with specific characteristics.

There are four developmental goals for adolescence: to become independent of family; to form close, personal relationships; to become comfortable with body and self-image; and to develop an individual identity, realistic life goals, the life skills to “get on” in the world and settle on personal, moral, religious, and sexual values. These four goals are accomplished stepwise as the child goes through the three stages of adolescence – early, middle, and late.

Early adolescence (11, 12, 13, 14) is the time of the dramatic physical changes of puberty. Early work on developmental goals begins in this stage. Independence: not as willing to do things with family; moody. Friends: form close friendships with teens of the same sex, usually one best friend. Body/self-image: worried about being normal, attractive; preoccupied with concerns about sexual maturation, including wet dreams and masturbation. Individual identity: feel watched; daydream; plan for the future although not necessarily realistic plans; begin to test limits; think about sex, which may lead to masturbation or wet dreams; lack impulse control; exaggerate personal problems out of proportion.

Middle adolescence (15, 16, 17) is the time of intense emotions and intense relationships with peers. Independence: argue with parents more than any other stage; turn to friends – not parents – for support. Friends: want to fit in with chosen peer group, including clothing, values, music; dating and sexual experimentation begin; may get involved in clubs, gangs, and other groups. Body/self-image: more comfortable with physical changes; physical attractiveness is important. Individual identity: consider the feelings of others; capable of more difficult thought processes; more realistic plans for the future; magical thinking about being able to take risks and not be harmed.

Late adolescence (18, 19, 20, 21) is the last step to adulthood. It can be a depressing time if the goals for early and middle adolescence were not successfully reached. Independence: become closer to family again; more likely to accept advice. Friends: less dependent on group activities; more time spent in meaningful relationship with one partner. Body/self-image: OK with body. Individual identity: develop practical, realistic career goals; able to compromise; settle on personal, moral, religious, and sexual values.

The 21-year-old who is socially and emotionally independent of parents while still close to them, who is comfortable with himself/herself as an adult, and who is capable of meaningful relationships has successfully completed the passage from childhood to adulthood.

Physical Growth

Growth during adolescence is linked to the hormonal changes of puberty. Girls usually enter puberty earlier than boys.

Girls
The age that your daughter enters puberty depends on several factors including her general health, her nutritional status, and family history.
You can predict the order of the changes associated with puberty, but you can’t predict the timing. Girls usually develop breast buds before pubic and axillary hair. About two years later, menstrual periods begin. A growth spurt begins before breast budding and ends before periods begin.

Boys
You can predict the order of the changes associated with puberty, but you can’t predict the timing. Boys usually begin puberty with enlargement of the testicles and scrotum. Pubic hair begins to grow. At the same time, boys may begin to ejaculate. The penis becomes longer and thicker. At the same time, hair grows on the face and underarms and the voice deepens. A growth spurt begins at the same time pubic hair appears and usually lasts 24 to 36 months.

Useful Info: Growing Like a Weed

Teens are more likely to shoot up in height in the spring and summer. Hands and feet grow first, followed by arms and legs, and finally chest and trunk.

Useful Info: See How They Grow

The inches and pounds added during adolescence count in a big way.
Inches added to height = 25 percent of final adult height
Pounds added to weight = 50 percent of final ideal weight

Health Alert: When Puberty Comes Too Early

Call your doctor for an appointment for the following:

Girls
Before age 7-8: Breast development or pubic hair
Before age 10: Menstrual periods

Boys
Before age 9: Enlargement of the testicles and scrotum or pubic hair

Health Alert: When Puberty Comes too Late

Call your doctor for an appointment for the following:

Girls
At age 13: No signs of breast enlargement
At age 16: No menstrual periods

Boys
At age 14: No testicular enlargement

Useful Info: What You and Your Daughter Should Know About Breast Cancer

Routine self-examination of the breast should be taught at puberty.

Cancer of the breast is unusual before age 25. However, over an entire lifetime, 1 in 8 women will have breast cancer.

A history of a sister or mother with breast cancer increases the risk of cancer.

Breast cancer is most often discovered during self-examination.

When discovered by a routine self-exam, breast cancer usually has a better outcome.

Routine self-exams make early discovery of a change from normal shape or feel of the breast more likely.

Once a month (at the end of her menstrual period), your daughter should check each breast for a lump that is firm and nonmovable, a dimple on the skin, a change from the normal shape or feel, or discharge from the nipple. The most common place for breast cancer is under the nipple and in the upper fourth of the breast above the nipple and on the side toward the armpit.

Ask the doctor to show your daughter how to do a self-exam.

Be sure your daughter knows the signs that require prompt evaluation – a lump that is firm and nonmovable, a dimple on the skin, a change from the normal shape or feel, or discharge from the nipple.

Healthy Habits: How to Perform a Breast Self-Exam

The exam is easiest to perform during a shower or bath when the skin is soapy, making a lump easier to feel as your fingers slide over the slippery skin. It is normal to feel the glandular portion of the breast in the shape of a comma with the “tail” of the comma leading up from the center of the breast to the underarm area.

Using your flattened fingers, feel for lumps or tenderness beginning with the area under the nipple and moving outward to cover the entire breast in a circular pattern. (Do not use the tips of your fingers since they are too sensitive and can mistake the uneven texture of normal breast tissue for lumps.) Check for areas where the skin of the breast feels “stuck” to the tissue under it. (You may see a dimple or a pucker over this area when you look in the mirror.)
Gently squeeze each nipple to check for discharge.
Call your doctor for an appointment if you find a firm, nonmovable lump, a dimple on the skin, a change from the normal shape or feel, or discharge from the nipple. Do not check and recheck the abnormal finding. Leave it alone and see a doctor.
Do not put off your call to the doctor hoping the problem will go away on its own.

Useful Info: What You and Your Son Should Know About Cancer of the Testis

Routine self-examination of each testis should begin at age 13 or 14.
Cancer of the testis is the most common solid tumor of young men.
Cancer of the testis is most often discovered during self-examination.
When discovered early, cancer of the testis is highly curable.
A history of only one testis or an undescended testis increases the risk of cancer. Both the surgically “brought down” testis and the normally descended testis are at increased risk for cancer.
Once a month, your son should check each testis for a lump, increase in size, or unusual tenderness.
Ask the doctor to show your son how to do a self-exam.
Be sure your son knows the signs that require prompt evaluation – a lump, increase in size, or unusual tenderness.

Health Alert: Sudden Groin Pain

Seek care immediately for sudden “knife-like” groin pain (frequently so severe there is nausea and vomiting) in males age 12 and older.

The most common cause of sudden groin pain in this age group is testicular torsion or twisting of the blood supply to the testis. Emergency surgery within four to six hours is required to prevent permanent damage to the testis.

Healthy Habits: How to Perform a Testicular Self-Exam

The exam is easiest to perform after a shower when the skin of the scrotum is relaxed. It is normal to feel a soft bumpy area on the top and behind the testis – this is the epididymis. The firm, rope-like structure on the back and above the testis is the vas deferens.

Holding the testis between your thumb and fingers, roll the testis between your fingers feeling for lumps or unusual tenderness. Check to be sure there is no difference in size between the two testes.
Call your doctor for an appointment if there is an abnormal or questionably abnormal finding. Do not check and recheck the abnormal finding. Leave it alone and see a doctor.
Do not put off your call to the doctor hoping the problem will go away on its own.

Questions & Answers

Q: My 14-year-old son has what feels like a rubbery, movable lump under his right nipple. Could he have breast cancer?

A: In early puberty, it is not uncommon for boys to have a lump or nodule beneath one or both nipples. A nodule may or may not be painful. These nodules usually disappear within 12 to 18 months as male hormone levels increase. There is no reason to be concerned about breast cancer.

Useful Info: Medical Confidentiality

“But I pay the bill”

During adolescence, it is appropriate for your teen to take an active role in his or her personal health and medical care. Until now, your child’s health was your responsibility. In adolescence, most of that responsibility shifts to your teen.

By accepting an adult responsibility, your teen earns the right to doctor-patient confidentiality. Confidentiality is important for open, honest communication. Your teen must trust that private conversations will remain private – off limits even to you!

There are situations in which your doctor learns information that cannot be kept in confidence. For instance, if your doctor learns that a life is in danger, such as a possible suicide attempt, your doctor will inform you so that together, you can take the steps necessary to prevent a tragedy.

Your teen’s physician knows you are extremely concerned about your child’s well-being. If you feel the need to discuss your concerns or ask for parenting advice, consider requesting an appointment for a parenting consultation.

Safety Habits: In Case of an Auto Accident

Be sure your teen knows what to do if involved in a motor vehicle accident. Stress the importance of remaining at the scene. Write out simple directions on a 3 x 5 card (including insurance information) and place it in the glove compartment of the car, along with auto registration.

Useful Info: It's the Law!

Under usual circumstances, the parent/legal guardian must provide consent for medical care of a minor considered by law to be a person under age 18. However, the State of Indiana authorizes minors to consent for their own medical services under certain conditions. These include: emergency care for a life-threatening condition; examination and treatment for sexually transmitted diseases, including HIV and AIDS; and evaluation and treatment for alcoholism or alcohol or drug abuse at a facility approved by the Division of Addictive Services.

Although the State of Indiana does not directly address the legal rights of minors regarding medical consent for contraceptive services, that right is indirectly assumed under federal case law.

Safety Habits: Just in Case...

Chances are the police will stop your teen for a motor vehicle violation sometime in the teen years. Because police officers must be constantly alert for suspicious activity or the threat of harm, teens need to be careful not to alarm the officer by sudden movements or unpleasant words. Just in case your teen is pulled over by the police, rehearse the following with your teen:

Pull over to the side of the road.

Stay seated in the car with both hands on the steering wheel.

Be polite, answering questions with respect.

Follow directions and cooperate with police requests, such as taking breathalyzer test.

Do not drive away until you have been given permission.

Health Alert: Looking Out for Your Teen

If your teen has a substance abuse problem, get your child into therapy immediately. Deal with the situation as you would an illness, accepting the problem and putting your energy into supporting your child’s recovery.

Signs of substance abuse
Although almost any one of these signs can appear in a normal, nondrug-using teen, if you see several of these signs together, your child may have a substance abuse problem.

Call your doctor to find out how to get help if your child:
spends too much time alone; stops talking or argues frequently with family members; drastically changes style of dress or hair; ignores homework and has dropping grades; drops old friends; has new friends who are less familiar and less friendly to adults; has frequent or unexplained injuries; sleeps poorly or complains of tiredness; develops irregular eating habits; has bloodshot eyes, very large or small pupils; has frequent “colds” or nosebleeds; has unusual odors on clothing; seems “jumpy” or hyperactive; has mood swings including irritability, depression, hostility, or paranoia; keeps drug paraphernalia; attempts to or runs away from home; or steals money or valuables from your home. Remember, children need love most when they are the most unlovable.

Useful Info: Family Feuding

From your teen’s 14th birthday through the 16th year, you can expect to have some trying times. These are the years when you are most likely to have difficulty getting along with your teen and your teen will have the most difficulty getting along with you.

Several studies have been reported about family relationships during the teen years. Compare your family’s experience with the following:

Ninety percent of 16-year-old teens report getting along well with their mother. Seventy-five percent report good relations with their dad.
Adolescent girls report a minor conflict with parent every one-and-a-half days. Adolescent boys report a minor conflict every four days. Seventy-five percent of the conflicts are between mother and teen. Mother-daughter conflicts last an average of 15 minutes. Mother-son conflicts last an average of six minutes.
Only 1 in 5 families reports serious difficulty with parent-child relationships.

Late to Bed, Late to Rise

Weekend morning sleep-ins are your teen’s way to make up for missed sleep. Teens need nine to 10 hours of sleep per night.

Chronic daytime sleepiness, poor grades in morning classes, or drowsiness when driving are signs that your teen needs a better sleep routine every day of the week.

Health Alert: Take These Signs Seriously

If your teen shows signs of serious depression, get help for your child immediately. Deal with the situation as you would an illness, accepting the problem and putting the energy into supporting your child’s recovery.

Signs of depression
Teens are often moody, dress in black day after day, and can’t seem to hear anything you say. While you will learn to ignore some behaviors, other behaviors are signs of a serious problem and must not be ignored.

The following are warning signs of severe depression. Call your doctor and ask for help if your child: constantly complains of stomachaches, headaches or tiredness; sleeps too much or too little; loses or gains weight very quickly; neglects appearance; increases risky behaviors – drugs, alcohol, unsafe sex, and drinking and driving; loses interest in school and friends – falling grades, dropping out of activities, cutting classes and withdrawing from friends and family; seems suddenly cheerful after a long period of depression; makes statements like “I feel dead inside;” seems preoccupied with death in choice of music and clothing and talks frequently about friends who have died; or gives away prized possessions, writes a will, or makes other “final” arrangements.

Health Alert: A Matter of Life and Death

Call a suicide crisis hotline, local emergency department, 911, or your child’s doctor if your child: complains of feeling hopeless; says, “I’d be better off dead;” or has a specific plan for committing suicide. Take suicide seriously.

Risk factors for suicide
Suicide is the third leading cause of death in the teen years. For every
teen suicide, there are 200 suicide attempts. Risk factors include:

previous suicide attempts

family history of suicide

friends who have committed suicide

access to a gun

history of mood, conduct, or psychotic disorders

problems with impulse control

concerns about sexual identity, homosexuality

history of physical or sexual abuse

depression

Source: Bright Futures, 2nd edition

Useful Info: A Call to Action

The SOS (Signs of Suicide) Program trains people how to ACT if a friend or child is severely depressed and possibly suicidal. ACT stands for Acknowledge, Care and Treatment (for teenagers, the “T” stands for “Tell a responsible adult”). Call 1.800.573.4433 to locate a training site.